Abstract
Background: Disability has not been studied after emergency treatment of bleeding esophageal varices (BEV). We created a disability index (DI) in a randomized controlled trial comparing emergency endoscopic therapy (EST) versus emergency portacaval shunt (EPCS). Methods: There were 211 unselected, consecutive patients with cirrhosis and acute BEV who were randomized to EST (n = 106) or EPCS (n = 105). Diagnostic work-up and treatment were performed within 8 hours. Ninety-six percent underwent more than 10 years follow-up evaluation. Disability was measured by assessing 9 factors to create a DI. Results: Ten-year survival was 8% after EST versus 51% after EPCS (P <.001). EPCS had a significantly better DI. The EST and EPCS values were as follows: liver function improvement: not applicable and ++; worsening liver function, ++ and not applicable; portal-systemic encephalopathy (PSE) incidence, 36 and 15; PSE episodes, 179 and 94; packed red blood cell units, 1,005 and 320; hospital readmissions, 387 and 292; and number of readmission days, 9.6 and 4.7. All of the P values were less than.001. Conclusions: EPCS resulted in a markedly better DI than EST, a significantly higher survival rate, better control of bleeding, and a lower incidence of PSE. EPCS is an effective first-line emergency treatment of BEV.
Original language | English (US) |
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Pages (from-to) | 157-166 |
Number of pages | 10 |
Journal | American journal of surgery |
Volume | 204 |
Issue number | 2 |
DOIs | |
State | Published - Aug 2012 |
Keywords
- Bleeding varices
- Endoscopic sclerotherapy
- Portacaval shunt
- Quality of life
ASJC Scopus subject areas
- Surgery